Provider Demographics
NPI:1366888026
Name:CENEVIZ, CAROLINE (DDS)
Entity type:Individual
Prefix:
First Name:CAROLINE
Middle Name:
Last Name:CENEVIZ
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1350 SPRING ST NW
Mailing Address - Street 2:SUITE 600
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30309-2864
Mailing Address - Country:US
Mailing Address - Phone:770-692-1000
Mailing Address - Fax:
Practice Address - Street 1:4125 BUFORD DR STE K
Practice Address - Street 2:
Practice Address - City:BUFORD
Practice Address - State:GA
Practice Address - Zip Code:30518-3459
Practice Address - Country:US
Practice Address - Phone:770-692-1000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-05-21
Last Update Date:2013-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA222451223G0001X
GADN0145261223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
No1223G0001XDental ProvidersDentistGeneral Practice